Introduction
RehabCare operates more than 70 CARF (Commission on the Accreditation of Rehabilitation Facilities) accredited inpatient rehabilitation units. In fact, one hundred percent of RehabCare-operated units seeking CARF accreditation have received it. All of our units are managed to meet CARF standards.
The average length of stay in a RehabCare-operated IRF is 15 days —12 percent lower than the national average — and we’ve demonstrated our ability to effectively address the reimbursement changes resulting from PPS legislation. We’ve also earned a reputation for high customer, patient and physician satisfaction. RehabCare is the VHA-preferred provider for rehabilitation and has one of the highest satisfaction ratings of all VHA suppliers.
We consistently receive a 98 percent patient satisfaction rating inpatient surveys executed at time of discharge and 90 days post-discharge.
We believe that a rehabilitation patient’s ability for success increases with a strong working relationship among the rehabilitation staff, physicians, admitting personnel, and caregivers. Services are provided to patients through a cohesive interdisciplinary team consisting of rehabilitation nurses, psychological and social services, and physical, occupational, recreational and speech therapists. The team operates under the guidance of a Program Director and a Medical Director — typically a neurologist, physiatrist, or a physician who specializes in physical medicine and rehabilitation.
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Pre-screening and Admission
Prior to admission, each patient undergoes a thorough on-site pre-screening process to evaluate his or her rehabilitation potential. A decision of acceptance or denial usually is made within four hours. If clinically qualified, physicians will admit patients to the rehab unit and a detailed treatment plan with specific goals is then developed in conjunction with the rehabilitation team, the patient, and his or her physician. For patients who do not meet admission criteria, RehabCare’s team works with the hospital’s case managers to determine appropriate care alternatives.
The interdisciplinary rehabilitation team holds weekly clinical meetings to discuss each patient’s progress toward functional goals. The patient’s primary care physician is invited to clinical meetings and is kept informed of progress through regular communications via outcome reports generated from ProMOS, our proprietary management information software that facilitates treatment planning, tracking and reporting.
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Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF/PAI)
The team also ensures all functional coding information complies with Inpatient Rehabilitation Facility/Patient Assessment Instrument (IRF/PAI) regulations, appropriate accreditations standards are met, and policies and procedures are developed and followed according to state regulations and PPS. Regulations require that the data collected demonstrate improvement in functional levels and collaborate the therapy’s role in improving function.
Under Medicare regulations, IRF/PAI data must be completed for each patient twice during his or her stay. To ensure that this vital data is collected in a timely and accurate manner, RehabCare has invested significantly in our ProMOS system.
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The ProMOS System
ProMOS is an innovative Web-based system that allows team members of an acute rehabilitation program to capture significant functional, operational, and demographic information. Such information can be used to ensure the program is run efficiently and within program standards set by state and federal regulations and RehabCare policies and procedures. The system also provides us with cutting-edge referral development technology.
Information is collected from the beginning to the end of each patient’s involvement with the rehab program to gather functional and demographic data. The system is formalized by ensuring that every three months, outcome information is reviewed by the team and distributed to all pertinent areas in the host hospital, including upper-level management.
An annual review of the system and its outcome determines the system’s effectiveness and efficiency. Individual unit information can also be compared in aggregate with a database of more than one hundred RehabCare rehabilitation programs.
Because patient satisfaction is a vital measure for RehabCare, a standard patient satisfaction survey is available in ProMOS that assesses satisfaction at discharge and 90 days post-discharge.
ProMOS enables RehabCare to manage operational outcomes and individual patient episode tracking. Criteria measured include, but are not limited to: functional assessment, intensity of services provided, level of care management (CMGs), and follow-up tracking.
Tracking tools include:
- revenue/cost,
- marketing contact,
- patient/unit goal, and
- staff productivity.
The revenue/cost-tracking tool measures controllable costs for the unit, such as direct nursing, therapy, and other costs per day ancillary items.
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Performance Improvement Plan
In addition to ProMOS, each rehabilitation unit maintains a Performance Improvement Plan (PIP), which is updated annually. The PIP establishes a process for each IRF to continually measure, assess and improve processes related to IRF services. Each RehabCare IRF reviews its scope of services and goals and maintains quality control measures as appropriate. The substantive results of the quality review program are reported to the hospital’s quality committee (or other appropriate committee) on a quarterly basis.
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Monthly Reporting
Each month, the RehabCare Program Director submits a report that includes the month’s average census, clinical, operational, and marketing activities, and goals for the following month. These reports can be customized to meet the needs of our partner facility.
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Discharge Planning and Follow Up
Prior to discharge, RehabCare’s rehabilitation team meets with the patient and his or her family to make sure that the necessary support system is in place once the patient is discharged. Arrangements may be made for equipment, prosthetic management, driving evaluations, home health or outpatient therapy, lab draws, nursing services, wound care, appropriate medications, and medical follow-up. A formal, written plan of continued care is developed and provided to the patient and family upon discharge.
RehabCare’s team makes a follow-up call to the patient after two weeks and again three-months post-discharge to ensure all services are in place and the patient is progressing as planned. Any existing problems are reviewed at that time. Some of the physical issues that may need to be assessed at this time include the success of the patient in adapting to the living environment and his/her ability to function independently, the patient’s medical and rehabilitation regimens, swallowing precautions, nutrition and hydration, and prevention of skin breakdown.
As important as the physical state of the patient, his/her mental state must also be examined. For example, major depression occurs in 10-27 percent of patients following a stroke. The coping mechanisms of the family/caregivers are also at risk and should be monitored, not only for their well being, but to ensure that the patient is provided the comfort, safety and dignity he or she requires.
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